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MC can only be diagnosed by histological examination of colonic biopsies (subepithelial collagen band &gt;10 \u00b5m (collagenous colitis) or &gt;20 intraepithelial lymphocytes per 100 epithelial cells (lymphocytic colitis), both with lamina propria inflammation). The UK National Health Service exerts downward pressure to minimise colonoscopy referrals. Furthermore, biopsies are often not taken according to guidelines. These factors work against MC diagnosis. In this review, we note the high incidence of MC (comparable to ulcerative colitis and Crohn\u2019s disease) and its symptomatic overlap with irritable bowel syndrome. We also highlight problems with the recommendation by National Health Service\/National Institute for Health and Care Excellence guidelines for inflammatory bowel diseases that colonoscopy referrals should be based on a faecal calprotectin level of \u2265100 \u00b5g\/g. Faecal calprotectin is &lt;100 \u00b5g\/g in over half of individuals with active MC, building into the system a propensity to misdiagnose MC as irritable bowel syndrome. This raises important questions\u2014how many patients with MC have already been misdiagnosed, and how do we address this silent burden? Clarity is needed around pathways for MC management; MC is poorly acknowledged by the UK healthcare system and it is unlikely that best practices are being followed adequately. There is an opportunity to identify and treat patients with MC more effectively.<\/jats:p>","DOI":"10.1136\/flgastro-2019-101227","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T17:15:23Z","timestamp":1562346923000},"page":"228-234","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Undiagnosed microscopic colitis: a hidden cause of chronic diarrhoea and a frequently missed treatment opportunity"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4703-581X","authenticated-orcid":false,"given":"Andreas","family":"M\u00fcnch","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Science, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S","family":"Sanders","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Molloy-Bland","sequence":"additional","affiliation":[{"name":"Oxford PharmaGenesis, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Pali S","family":"Hungin","sequence":"additional","affiliation":[{"name":"The Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,7,5]]},"reference":[{"key":"2025090708192445000_11.3.228.1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/0016-5085(80)90575-2","article-title":"Chronic diarrhea of unknown origin","volume":"78","author":"Read","year":"1980","journal-title":"Gastroenterology"},{"key":"2025090708192445000_11.3.228.2","doi-asserted-by":"crossref","unstructured":"Lewis NR , Archer T , Kaye P . 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